Abstract
Normal hearts comprise 2 × 109 myocytes, but this number may be doubled in excessively hypertrophied hearts. After a heart attack caused by blockage of one of the arteries that supply the heart, approximately 20% or more of cardiomyocytes are acutely and irreversibly lost in the ischemic area. However, the damage is not limited to the acute interruption of blood flow. Reperfusion of the ischemic territory can cause additional damage due to a burst of toxic reactive oxygen species. Moreover, additional cardiomyocytes are lost in the peri-infarct area during the subacute phase, leading to extension of the infarcted area. The ensuing remodeling response, which consists of cardiomyocyte hypertrophy and collagen accumulation, is insufficient to compensate for the massive cell loss, thus leading to scar expansion, ventricular chamber dilation, and failure.
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